Eye Trauma

Question 1

How can you categorise eye trauma?

Answer 1

Blunt
lacerating
chemical

Question 2

How do we classify blunt trauma to the eye?

Answer 2

Mild - moderate
e.g. bruise to the ocular tissues with the eye wall intact

Moderate - severe
e.g. rupture eye wall
very severe consequences

Question 3

What is a lacerating trauma to the eye

Answer 3

“cut” to the eye wall

outcome depends on extent / location

Question 4

What causes can you think of for ocular trauma?

Answer 4

Foreign bodies

Corneal abrasions

Disruption of globe

Intraocular foreign bodies

Hyphemas

orbital wall fractures

Chemical injury

Question 5

What do these show ?

Answer 5

chemical burns ranging from mild inflammation to severe damage

Question 6

You see this what do you do?

Answer 6

IRRIGATE NOW
alkali burn

Question 7

How do acid injury’s to eye cause damage?

Answer 7

denaturation and coagulation of protein

acid damaged limited by neutralisation of the buffering nature of tissues

Question 8

What often causes acid injury to the eye?

Answer 8

Sulfuric / nitric acids

Industrial accidents
Car battery explosions

Question 9

Compare the damage from acid vs alkali burns

Answer 9

Acid = damage confined to area of contamination

Alkali = damage widespread, uncontrolled and progressive

Question 10

How do alkali burns cause damage to the eye?

Answer 10

Penetrate ocular tissues rapidly, produce intense ocular reactions

epithelial loss
corneal opacification
scarring
severe dry eyes
cataract
glaucoma
blindness

Question 11

Treatment for chemical injury to eyes?

Answer 11

IRRIGATION - complete and copious!
within minutes

Question 12

Describe how you would irrigate the eyes of a pt with chemical injury to the eyes?

Answer 12

Drop of topical anesthetic if available (proparicaine)

eye irrigation solution and normal saline IV drip

Squeeze copious solution into the eye, direct towards temple (AWAY from unaffected eye)

Irrigate under the lids

Question 13

When should you check pH of eyes with a pt with a chemical injury?

Answer 13

After several mins of irrigation check with litmus paper placed at inferior fornix

resume irrigate until pH neutralised

check pH 30 mins post irrigation as can rise again

Question 14

What is hyphema?

Answer 14

Blood in anterior chamber
often associated with trauma
Emergency referral

Question 15

What is this?

Answer 15

Hyphema

Question 16

Treatment for hyphema?

Answer 16

Bedrest - so don’t re-disperse blood that has settled
topical steroids
topical cycloplegic agents
admit if young / concerned compliance
Daily exam in 5 days (including IOP)
Sickle cell - pts need more aggressive management on increased IOP

Question 17

If a pt has hyphema what do you need to asses for ?

Answer 17

orbital compartment syndrome e.g. secondary to retrobulbar haemorrhage

Question 18

What are the features of orbial compartment syndrome?

Answer 18

Eye pain / swelling

proptosis

‘rock hard’ eyelids

relative afferent pupillary defect

Question 19

How do you manage orbital compartment syndrome?

Answer 19

Urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit

Question 20

Orbital wall fractures can causes what?

Answer 20

‘Blow out fracture’ causing damage to the orbital floor and muscle entrapment / fat into maxillary sinus

Question 21

What ocular muscle does a blowout fracture typically affect?

Answer 21

Entrapment of inferior rectus

pt cannot elevate the eye

Question 22

How would you investigate blow out fracture?

Answer 22

CT

Question 23

Causes of blowout fracture

Answer 23

blunt trauma e.g. golf ball,fist knee into eye from a dashboard in car injury

Question 24

Symptoms of orbital blow out fracture

Answer 24

Periorbital ecchymosis

oedema

inability to elevate the globe

Vertical diplopia

Hypoaesthesia over the distribution of the infraorbital nerve

Depression of the globe

Enophthalmos = sunken in.